Wisconsin Legislature: DHS 102.036 History

(d) Social security number, subject to all of the following requirements:

1. Services must not be denied or delayed to an otherwise eligible individual pending issuance or verification of the individual’s social security number by the Social Security Administration.

2. Any of the following individuals are not required to provide a social security number:

a. Individuals who are deemed eligible for MA, based on being born to a pregnant woman eligible for MA in Wisconsin, until they turn 1 year of age.

b. Individuals who are not eligible to receive a social security number.

c. Individuals who do not have a social security number and may only be issued a social security number for a valid non-work reason in accordance with 20 CFR 422.104.

d. Individuals who refuse to obtain a social security number because of well-established religious objections, as provided in s. 49.82 (2) (b) 3., Stats.

(e) Age.

(f) Citizenship subject to s. DHS 102.035.

(g) Disability, blindness, or both.

(h) Assets.

(i) Residence.

(j) Immigration status, subject to s. DHS 102.036.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; emerg. am. (1), eff. 7-1-99; am. (1), Register, March, 2000, No. 531, eff. 4-1-00; corrections in (3) (b) and (c) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 21-067: cr. (4) Register March 2022 No 795, eff. 4-1-22, r. (4) eff. the first day of the month after the emergency period, as defined in 42 USC 1320b-5 (g) (1) (B) and declared in response to the COVID-19 pandemic, ends; correction in (4) made under s. 35.17, Stats., Register March 2022 No. 795; CR 23-046: am. (1), cr. (1g), (1r), am. (3) (intro.), (a), (b), r. (3) (c), renum. (3) (d) to (3) (d) (intro.) and am., cr. (3) (d) 1., 2., am. (3) (e) to (h), cr. (3) (j) Register April 2024 No. 820, eff. 5-1-24; correction in (3) made under s. 13.92 (4) (b) 7., Stats., and correction in (1g) made under s. 35.17, Stats., Register April 2024 No. 820.

DHS 102.035 Verification of United States citizenship.

(1) The agency shall verify citizenship through a data match with the Social Security Administration. If citizenship cannot be verified through a data match with the Social Security Administration, the agency must verify citizenship through satisfactory documentary evidence as specified in s. 49.84 (6) (d), Stats., except that any of the following are exempt from the requirement to verify citizenship:

(a) Individuals receiving supplemental security income benefits under 42 USC 1381-1383f.

(b) Individuals entitled to or enrolled in any part of Medicare.

(c) Individuals receiving disability insurance benefits under 42 USC 423 or monthly benefits under 42 USC 402, based on the individual’s disability.

(d) Individuals who are in foster care and who are assisted under 42 USC 621-629m, and individuals who are beneficiaries of foster care maintenance or adoption assistance payments under 42 USC 670-679c.

(e) Individuals who are or were deemed eligible for MA in Wisconsin on or after July 1, 2006, based on being born to a pregnant woman eligible for MA.

(2) The agency shall not re-verify or require an individual to re-verify citizenship at a renewal of eligibility or upon a subsequent application following a break in coverage.

(3) If citizenship cannot be promptly verified, a reasonable opportunity period of 95 days shall be provided to applicants during which efforts must continue to obtain verification or, if necessary, request documentation. Benefits may not be delayed, denied, reduced, or terminated during the reasonable opportunity period if the individual is otherwise eligible for MA. A reasonable opportunity period shall only be granted once for verification of an individual’s U.S. citizenship.

History: CR 23-046: cr. Register April 2024 No. 820, eff. 5-1-24.

DHS 102.036 Verification of immigration status.

(1) The agency shall verify immigration status of persons declaring a satisfactory immigration status either through the electronic service established by the U.S. department of health and human services, or the department of homeland security.

(2) Persons applying for MA emergency services provided under 42 USC 1396b(v) or applying for an unborn child under s. 49.471, Stats. shall not be required to verify their immigration status.

(3) If immigration status cannot be promptly verified, a reasonable opportunity period of 95 days shall be provided to applicants during which efforts must continue to obtain verification or, if necessary, request documentation. Benefits shall not be delayed, denied, reduced, or terminated during the reasonable opportunity period if the individual is otherwise eligible for MA. An additional reasonable opportunity period may be granted when a change in immigration status is reported.

(4) Unless the individual reports a change in immigration status or information is received that indicates a potential change in the individual’s status, the agency shall not re-verify or require an individual to re-verify immigration status at a renewal of eligibility or upon a subsequent application following a break in coverage.

History: CR 23-046: cr. Register April 2024 No. 820, eff. 5-1-24.

DHS 102.04 Eligibility determination.

(1) Decision date.

(a) As soon as possible but not later than 30 days from the date the agency receives a signed application completed to the best of the applicant’s ability, the agency shall determine the applicant’s eligibility for MA.

(b) If medical examination reports are needed to determine disability or blindness, the agency shall make the disability decision no later than 60 days from the date the agency receives the signed application.

(c) If a delay in processing the application occurs because of a delay in securing necessary information, the agency shall notify the applicant in writing of all of the following:

1. That there is a delay in processing the application.

2. The reason for the delay.

3. The applicant’s right to appeal the delay under s. 49.45 (5), Stats.

(2) Notice of decision. The agency shall send timely and adequate notice to applicants and recipients to indicate that MA has been authorized or that it has been reduced, denied or terminated. In this subsection, “timely” means in accordance with 42 CFR 431.211, and “adequate notice” means a written notice that contains a statement of the action taken, the reasons for and specific regulations supporting the action, and an explanation of the individual’s right under s. 49.45 (5), Stats., to request a hearing and the circumstances under which benefits will be continued if a hearing is requested.

(3) Review of eligibility. A recipient’s eligibility shall be redetermined in any of the following circumstances:

(a) When information previously obtained by the agency concerning anticipated changes in the individual’s situation indicates the need for redetermination.

(b) Promptly after a report is obtained which indicates a change in the individual’s circumstances that may affect eligibility.

(c) In accordance with sub. (5), no more frequently than once every 12 months for persons eligible for BadgerCare Plus or MA under s. 49.46 (1) (a) 15. or 49.47 (4) (a) 1., Stats.

(d) At least every 12 months for SSI-related persons and persons eligible for the medicaid purchase plan, in accordance with sub. (4), except that when a person is determined to be permanently blind or disabled the agency may consider their blindness or disability as continuing until it is determined that they are no longer blind or disabled.

(e) At any time the agency has a reasonable basis for believing that a recipient is no longer eligible for MA.

(5) Procedures for reviewing eligibility.

(a) A review of eligibility under sub. (3) (c) or (d) shall be conducted without requiring information from the individual if the agency is able to do so based on reliable information contained in the recipient’s case record or more current information available to the agency, including but not limited to information accessed through data bases accessed by the agency.

(b) If the agency is able to redetermine eligibility based on such information, the agency shall notify the recipient of all of the following:

1. The eligibility determination and basis.

2. The requirement that the recipient must inform the agency if any of the information contained in such notice is inaccurate, but that the recipient is not required to sign and return such notice if all information provided on such notice is accurate.

1. Provide the recipient with all of the following:

a. A renewal form containing information available to the agency that is needed to renew eligibility.

b. At least 30 days from the date of the renewal form to respond and provide any necessary information and to sign the renewal form.

c. Notice of the agency’s intended action concerning the renewal of eligibility.

2. Verify any information provided by the recipient.

3. Reconsider in a timely manner the eligibility of a person who is terminated for failure to submit the renewal form or necessary information, if the person subsequently submits the renewal form within 90 days after the date of termination without requiring a new application.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; emerg. am. (2) and (3) (c), eff. 7-1-99; am. (2) and (3) (c), Register, March, 2000, No. 531, eff. 4-1-00; am. (3) (d), Register, November, 2000, No. 539, eff. 12-1-00; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; CR 21-067: cr. (4) Register March 2022 No 795, eff. 4-1-22, r. (4) eff. the first day of the month after the emergency period, as defined in 42 USC 1320b-5 (g) (1) (B) and declared in response to the COVID-19 pandemic, ends; correction in (4) made under s. 35.17, Stats., Register March 2022 No. 795; CR 23-046: r. and recr. (1), am. (3) (intro.), (a) to (d), cr. (5) Register April 2024 No. 820, eff. 5-1-24; renumbering of (5) (b) to (5) (c) made under s. 13.92 (4) (b) 7., Stats., and correction in (5) (c) made under s. 35.17, Stats., Register April 2024 No. 820.

DHS 102.05 Fraud. When the agency director or a designee has reason to believe that fraud has been committed by an applicant or recipient, or by the representative of an applicant or a recipient, the case shall be referred to the district attorney.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.